Creating capacity: establishing a health education research agenda. Introduction.
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Forecasting↗
Biomedical subjects
K R McLeroy
Publications and source records attributed to K R McLeroy.
Creating capacity through health education: what we know and what we don't.
Researchers in health education have rarely convened to outline research priorities in the field. This article discusses the results of a meeting to develop a research agenda aimed at creating capacity to promote and maintain health. Salient research findings related to individual and community health are summarized and priority issues for future research are presented.
Community Health Services↗
Creating capacity: establishing a health education research agenda for special populations.
On Day 2 of the joint CDC/SOPHE conference on Creating Capacity: Establishing a Research Agenda for Health Education, the participants were asked to identify research needs or special issues in working with children and adolescents, the elderly, women, men, and underserved groups. This article presents the priority research areas across subgroups identified by the participants. The cross-group priorities are followed by research recommendations for each subgroup.
Adolescent↗
Community coalitions for health promotion: summary and further reflections.
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Community Health Services↗
Teachers' use of health curricula: implementation of growing healthy, project SMART, and the teenage health teaching modules.
This quasi-experimental study assessed impact of factors associated with classroom implementation of health curricula by North Carolina teachers. School representatives selected and implemented one of three tobacco prevention curricula--Project SMART, Growing Healthy, or the Teenage Health Teaching Modules--in either sixth or seventh grades. Prior to implementation, experimental teachers and administrators received extensive curricula training. Implementation data were collected through teacher completed checksheets and classroom observations for two time periods--initial implementation (n = 69) and maintained implementation (n = 136). While training was associated significantly with whether teachers implemented a curriculum (p < .05), other factors also were important. Variables outside of teachers' direct control, such as supportive administrators, context in which health instruction is taught, and turbulence, affected quantity and quality of curricular implementation.
Adolescent↗
Development of level of institutionalization scales for health promotion programs.
This study was conducted to test an instrument for measuring the level of institutionalization (LoIn) of health promotion programs. Institutionalization occurs when a program becomes an integral part of an organization, and the LoIn instrument is a beginning effort to measure the extent of program integration into organizations. The instrument is based on theory that holds that organizations are composed of production, maintenance, supportive, and managerial subsystems. Institutionalization occurs when a program becomes imbedded into these subsystems. A questionnaire designed to test this construct was mailed to 453 administrators in 141 organizations that operate health promotion programs. Based on 322 usable responses (71%), a confirmatory factor analysis was conducted. The results support the hypothesis of an eight-factor model: four factors concern how routinized the program was in each subsystem and four factors concern the degree of program saturation within each subsystem. Correlations of the eight factors with the number of years the programs had been in operation, and managers' perceptions of program permanency, indicated that the four routinization factors were more highly correlated with program longevity than the four niche saturation factors, and the niche saturation factors were more highly correlated with managers' perceptions of program permanence than the routinization factors. The instrument, which is available from the authors, may be used as both a research instrument and a diagnostic tool in assessing the institutionalization of health promotion programs.
Community Health Services↗
Toward integrating qualitative and quantitative methods: an introduction.
Both the qualitative and quantitative paradigms have weaknesses which, to a certain extent, are compensated for by the strengths of the other. As indicated in this article, the strengths of quantitative methods are that they produce factual, reliable outcome data that are usually generalizable to some larger population. The strengths of qualitative methods are that they generate rich, detailed, valid process data that usually leave the study participants' perspectives in tact. This article discusses how qualitative and quantitative methods can be combined and it introduces the articles included in this issue.
Anthropology↗
Practitioners' use of theory: examples from a workgroup.
There is a continuing discussion within the field of health education about the relationship between theory and practice. Much of this discussion, particularly that which appears in professional journals, has been developed by academicians and is prescriptive. That is, it identifies ways in which theory should be used by practitioners. The purpose of this article is to facilitate this ongoing discussion by providing descriptive information on how theory is used by a group of health educators who work for the same organization. This information is used as a springboard for discussion more generally about the nature of theory in health education. This article represents the thinking and experiences of a dozen health professionals, in reaction to the question. "How do you use theory in your practice?" The authors believe this information will be useful in helping theoreticians develop more useful theory and helping practitioners increase their understanding of the utility of good theory. The division between theory and practice in the field of health education represents a significant opportunity and challenge to the discipline if energy can be redirected from criticism of the other "camp" to effective collaboration and enhanced effectiveness of health education efforts.
Attitude of Health Personnel↗
The community hospital-based stroke programs in North Carolina, Oregon and New York--V. Stroke diagnosis: factors influencing the diagnostic evaluation of patients following acute stroke.
Among the 4129 patients of the Community Hospital-based Stroke Program, 30% had an unspecified stroke diagnosis. Since specific diagnosis and, perhaps, eventual treatment, derives in part from diagnostic testing, we examined the effect of clinical condition, geographic and demographic factors on the incidence of certain diagnostic tests after acute stroke. In this multivariable analysis, race, sex, history of hypertension and history of diabetes did not influence the chance of having any test, but older age strongly reduced the chances of receiving extensive evaluation. When CT scanning was available, the utilization of a CT as well as other diagnostic studies including cerebral angiography, radionuclide brain scan, EEG and EKG was increased. The odds of receiving a CT scan increased if the patient was married, and decreased with a history of previous stroke. A history of previous TIA increased the chance of having a cerebral angiogram while a history of cardiac disease decreased the chance. There were striking regional geographic differences in the use of CT, radionuclide brain scanning and cerebral angiography which may, in part, reflect differences between the availability of these technologies in urban and rural hospitals. These results indicate that evaluation of stroke patients remains heterogenous.
Aged↗
Promoting comprehensive school health programs through summer health promotion conferences.
This study reports on the evaluation of the second North Carolina Healthful Living Institute (HLI), a statewide conference to promote comprehensive school health education. A comparison of year one and year two evaluation results is included. Based on a theoretical framework derived from the theory of diffusion of innovations within organizations, the impact of the HLI was assessed by studying characteristics of school districts sending representatives to the HLI and the composition of teams from each school district, and using pretest and posttest measures of participants' perceptions of the importance of health as a content area and participants' perceptions of the importance of the various components of comprehensive school health. Results indicate the effect of school health promotion conferences is linked to characteristics of school district teams, with the Institute needing to attract more varied teams, and teams from smaller, rural districts.
Adult↗
Community hospital-based stroke programs in North Carolina, Oregon, and New York. IV. Stroke diagnosis and its relation to demographics, risk factors, and clinical status after stroke.
The use of diagnostic tests, the accuracy of stroke type diagnosis, and their relationship to outcome are important from the standpoint of patient management and health care costs. To address this issue, we examined the differences between stroke types in terms of demographics, risk factors, diagnostic tests, and clinical outcome in the 4,129 patients who comprise the Community Hospital-Based Stroke Program. Previous transient ischemic attacks were equally frequent among patients with embolic and those with thrombotic stroke. For all stroke types, previous stroke was as frequent as previous transient ischemic attacks. Hypertension and cardiac disease were the most common risk factors, but 10% of all stroke patients had no recognized risk factors. Intracerebral hemorrhage was most often associated with death (45%). There was a strong direct relation between in-hospital mortality and a decreased level of consciousness at admission. Overall, 30% of patients did not receive a specific stroke type diagnosis; these patients were elderly, usually nonwhite, and often had an altered level of consciousness at admission but had a risk factor profile similar to that of patients who received a specific stroke type diagnosis. In summary, our findings suggest the continued need for physician education about and refinement of stroke type diagnosis.
Aged↗
Tobacco prevention in North Carolina public schools.
The purpose of this study is to report on the extent of, and organization for, tobacco prevention education in North Carolina Public Schools. Moreover, issues for the diffusion of tobacco prevention curricula are discussed. A questionnaire examining tobacco education practices and curriculum within school districts was mailed to health education representatives in each of the North Carolina public school districts. One-hundred twenty-five usable questionnaires were returned for analysis (125/140 = 89.3%). Of the school districts responding to the survey, 101 (80.8%) reported having adopted a system-wide curriculum which includes tobacco-related instruction. Additionally, a large percentage of the school districts with an adopted curriculum were using commercially published materials (85.2%). Large tobacco producing counties in North Carolina were not significantly different than other counties in the adoption or public acceptance of school programs with a tobacco prevention component. However, school systems with an adopted, general tobacco use policy for the district were more likely to have adopted a district-wide tobacco education curriculum. Individual schools were also involved with multiple tobacco prevention curriculum and learning programs. In the sixth, seventh, and eighth grades, the sample reported using a total of twelve different programs. Many of these learning programs lacked necessary elements of effective programs. Key diffusion issues included the impact of multi-tobacco curricula use to the introduction of new and effective material, as well as the association between district-wide tobacco use policies and the adoption of curriculum.
Adolescent↗
An ecological perspective on health promotion programs.
During the past 20 years there has been a dramatic increase in societal interest in preventing disability and death in the United States by changing individual behaviors linked to the risk of contracting chronic diseases. This renewed interest in health promotion and disease prevention has not been without its critics. Some critics have accused proponents of life-style interventions of promoting a victim-blaming ideology by neglecting the importance of social influences on health and disease. This article proposes an ecological model for health promotion which focuses attention on both individual and social environmental factors as targets for health promotion interventions. It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes.
Community Health Services↗
The business of health promotion: ethical issues and professional responsibilities.
In the nine years since an entire issue of Health Education Quarterly (then Health Education Monographs) was devoted to considering ethical issues in health education, several important social changes have occurred which have substantially influenced the practice of that discipline. New practice contexts and ethical issues have resulted, which require a fresh look at both these new issues as well as those addressed in the earlier monograph. The importance of understanding the principles underlying the ethical dilemmas raised by the authors is emphasized as a concern for both the individual practitioner as well as the profession of health education itself. Recommendations for personal and professional action are made by the authors.
Codes of Ethics↗
Socioeconomic factors and Medicare supplemental health insurance.
This analysis was conducted to determine how personal and community characteristics affect coverage by private insurance to supplement Medicare. Data from the 1980 National Medical Care Utilization and Expenditure Survey were used. After controlling for health status, it was found that supplemental coverage was positively associated with education, income, number of self-reported chronic conditions, being white, being married, and having a regular source of care. Private coverage was negatively associated with Medicaid coverage and age. The only community characteristic associated with supplemental coverage was region. Consideration of local medical resources and economic measures did not change that.
Data Collection↗
Choice of payment plan in the Medicare capitation demonstration.
This article identifies factors that influence the choice between joining an HMO and remaining with the traditional fee-for-service system among aged Medicare beneficiaries in three communities. Sources of marketing information were found to be strongly and positively related to the decision to join the HMO. Among beneficiaries who had to switch providers to join, persons who had a prior usual source of care and those who were satisfied with the amount of paperwork required to use that source of care were less likely to enroll in the HMO. Persons who did not have to switch providers to join the HMO were more likely to enroll in the prepaid program if they were satisfied with the amount of paperwork involved in using the HMO prior to the demonstration. Differences among the three communities suggest that the barrier to HMO enrollment presented by having a prior source of care who is not affiliated with the HMO may attenuate as the number of competing HMOs in the community increases, making the medical care environment more competitive. In the community with the most HMOs, persons who already had supplemental insurance were less likely to enroll than those who did not. None of the six HMOs studied experienced adverse selection, based on pre-enrollment health status.
Aged↗
Self-efficacy and health education.
Bandura's theory of self-efficacy has been applied in many areas of health education including smoking cessation, pain control, eating problems, cardiac rehabilitation, and adherence to regimens. Consequently, self-efficacy has emerged as an important concept with which health educators should be familiar. Self-efficacy refers to one's belief in the ability to do a specific behavior. Self-efficacy is a principle connection between knowledge and action since the belief that one can do a behavior usually occurs before one actually attempts the behavior. Self-efficacy also affects the choice of behavior, settings in which behaviors are performed, and the amount of effort and persistence to be spent on performance of a specific task. This article will examine self-efficacy theory, describe sources of self-efficacy, and present applications of self-efficacy theory.
Female↗
Social networks and social support: implications for health education. Introduction.
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Community Health Services↗